Child Psychodynamic Psychotherapy and Therapist Pregnancy: Systematic Case Study

Schmidt, Fernanda Munhoz Driemeier; Gastaud, Marina Bento; Ramires, Vera Regina Röhnelt

doi:10.1590/1982-4327e2836

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Psychology of Health • Paidéia (Ribeirão Preto) 28 • 2018 • https://doi.org/10.1590/1982-4327e2836 copy

Child Psychodynamic Psychotherapy and Therapist Pregnancy: Systematic Case Study¹ 1 Derived article from Master dissertation of Fernanda Munhoz Driemeier Schmidt under the supervision of Professor Dr. Vera Regina Röhnelt Ramires, defended in 2016, at the Graduate Program in Clinical Psychology of UNISINOS. Support: Financing this study was carried out with the support of the Coordination for the Qualification of Higher Level Staff - Brazil (Portuguese acronym: CAPES) - Financing Code 001. And also with the support of the National Council of Scientific and Technological Development (Portuguese acronym: CNPq) - code of processes 471358/2014-2 e 311235/2014-0.

Psicoterapia Psicodinâmica de Crianças e Gravidez da Terapeuta: Estudo de Caso Sistemático

Psicoterapia Psicodinámica de Niños y Embarazo de Terapeuta: Estudio de Caso Sistemático

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study aimed to describe the characteristics of the psychodynamic psychotherapeutic process of a child with a pregnant therapist and to identify possible repercussions of this pregnancy in the treatment. A descriptive, longitudinal study was conducted, based on systematic single case study procedure. The participants were an eight-year-old girl and her therapist who became pregnant during treatment. Forty psychotherapeutic sessions were analyzed through Child Psychotherapy Q-Set procedure. The therapeutic process was divided into four periods related to the therapist’s pregnancy: (1) the therapist was not pregnant; (2) therapist knew of her pregnancy but the topic had not been verbalized; (3) the pregnancy was treated in the therapeutic setting; (4) return of maternity leave. The results demonstrated that the therapist has adopted a less neutral stance, used less limits, and breaks and pauses in treatment were increasingly discussed. It was concluded that the therapist´s pregnancy influences the therapeutic setting in a marked way.

Keywords:
psychoanalytic psychotherapy; child psychotherapy; psychotherapeutic process

Items	Overall average	Average time 1	Average time 2	Average time 3	Average time 4
Most characteristic items
31 - T asks for more information or elaboration.	8.28	8.25	8.20	8.32	8,36
6 - T is sensitive to C’s feelings.	8.20	8.08	8.20	8.26	8.29
28 - T accurately perceives the therapeutic process.	8.06	7.67	7.95	8.18	8.14
3 - T’s remarks are aimed at encouraging C’s speech.	7.70	8.17	7.95	7.65	7.07
88 - Material of the hour is meaningful and relevant to C’s conflicts.	7.56	7.58	7.20	7.79	7.50
76 - T makes links between C’s feelings and experience.	7.45	7.17	7.75	7.32	7.57
77 - T’s interaction with C is sensitive to the C’s level of development.	7.35	7.42	7.65	7.35	-
23 - Therapy session has a specific focus or theme.	7.25	7.25	7.10	7.26	7.43
86 - T is confident, self-assured [vs; uncertain or unsure].	7.25	7.92	7.35	7.03	-
82 - T helps C manage feelings.	7.16	7.00	7.50	7.18	-
38 - T and C demonstrate a shared vocabulary or understanding when referring to events or feelings.	7.15	-	7.30	7.09	7.36
67 - T interprets warded-off or unconscious wishes, feelings, or ideas.	7.10	-	7.30	7.38	7.36
97 - T emphasizes verbalization of internal states and affects.	7.10	7.33	-	7.18	-
64 - C draws T into play.	7.07	6.92	7.40	7.15	-
69 - C’s current or recent life situation is emphasized.	7.06	8.17	-	-	7.36
81 - T emphasizes feelings to help C experience them more deeply.	-	7.25	-	-	-
65 - T clarifies, restates, or rephrases C’s communication.	-	7.08	-	-	-
62 - T points out a recurrent theme in the C’s experience or conduct.	-	-	7.30	-	7.07
78 - C is compliant.	-	-	6.90	-	-
72 - C is active.	-	-	-	7.03	7.36
75 - Interruptions, breaks in the treatment, or termination of therapy are discussed.	-	-	-	-	7.93
46 - T interprets the meaning of C’s play.	-	-	-	-	7.07
53 - C conveys awareness of own internal difficulties	-	-	-	-	7.50
Least characteristic items
1 - C expresses negative feelings (e.g., criticism, hostility) towards T [vs. express approval or admiration].	2.86	2.92	2.50	-	-
20 - C is provocative; challenges the T or rules and boundaries of the therapy hour.	2.85	2.83	2.80	2.91	2.79
89 - T acts to strengthen existing defenses.	2.65	-	2.55	2.59	2.64
49 - C conveys or expresses mixed or conflicted feelings about the T.	2.62	2.17	2.40	2.85	2.79
95 - C’s play lacks spontaneity.	2.45	2.50	2.35	2.50	2.43
58 - C appears unwilling to examine thoughts, reactions, or motivations related to problems.	2.43	2.50	2.65	2.38	2.21
42 - C ignores or rejects T’s comments and observations.	2.15	2.33	2.25	2.12	1.93
26 - C is socially misattuned or inappropriate.	2.02	2.25	2.10	2.03	1.71
17 - T actively exerts control over the interaction (e.g., structuring, introducing new topics).	1.97	2.25	1.90	1.91	2.00
56 - C is distant from his or her feelings.	1.91	1.58	2.10	1.94	1.86
18 - T is judgmental and conveys lack of acceptance.	1.77	1.67	1.70	1.68	2.21
5 - C has difficulty understanding the T’s comments.	1.73	1.75	1.70	1.76	-
40 - C communicates without affect.	1.72	1.75	1.65	1.71	1.86
41 - C does not feel understood by T.	1.62	1.58	1.55	1.68	1.64
9 - T is nonresponsive [vs; affectively engaged].	1.12	1.25	1.15	1.09	1.07
57 - T attempts to modify distortions in C’s beliefs.	-	2.92	-	-	-
37 - T behaves in a didactic manner.	-	-	-	2.79	2.36
5 - C has difficulty understanding the T’s comments.	-	-	-	-	1.71

Item	Item description	Manova	Tukey
Item	Item description	F	Times	Difference of averages between periods	Item direction
4	There is discussion of why C is in therapy.	6.64**	1-2	1.66*	↓
			1-3	1.59 *	↓
			2-4	-1.68*	↑
			3-4	-1.60*	↑
32	C achieves a new understanding or insight.	3.95*	1-4	-2.71*	↑
35	C’s self-image is a theme.	3.64*	1-4	-1.52*	↑
43	T suggests the meaning of the behavior of others.	3.60*	2-4	-.79*	↑
43	T suggests the meaning of the behavior of others.	3.60*	3-4	-.67*	↑
46	T interprets the meaning of C’s play.	3.91*	3-4	-1.27*	↑
48	T sets limits.	4.81**	1-3	.72 **	↓
48	T sets limits.	4.81**	1-4	.82**	↓
54	C is clear and organized in verbal expression.	2.94*	1-4	.90*	↓
61	C feels shy and embarrassed [vs; un-self-conscious and assured].	4.25*	1-4	2.08*	↓
61		4.25*	2-4	1.60*	↓
67	T interprets warded-off or unconscious wishes, feelings, or ideas.	3.83*	1-2	-1.63*	↑
			1-3	-1.76*	↑
			1-4	-1.69*	↑
69	C’s current or recent life situation is emphasized.	3.08*	1-3	1.40*	↓
75	Interruptions, breaks in the treatment, or termination of therapy are discussed.	7.12**	1-4	-2.51**	↑
			2-4	-2.38**	↑
			3-4	-2.19**	↑
87	T informs C of the potential impact of his or her behavior on others (not including T).	3.03*	2-3	-.70*	↑
93	T is neutral.	3.66*	1-3	1.34*	↓
94	C feels sad or depressed [vs. cheerful and joyous].	3.64*	1-3	.96*	↓

Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Programa de Pós-Graduação em Psicologia Av.Bandeirantes 3900 - Monte Alegre, 14040-901 Ribeirão Preto - São Paulo - Brasil, Tel.: (55 16) 3315-3829 - Ribeirão Preto - SP - Brazil
E-mail: paideia@usp.br

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[1] Correspondence address: Fernanda Munhoz Driemeier Schmidt. Universidade do Vale do Rio dos Sinos. São Leopoldo-RS, Brazil. CEP 93.022-000. E-mail: fernandadriemeier@hotmail.com